Effect of invasive strategy on long-term mortality in elderly patients presenting with acute coronary syndrome
Samet Yilmaz1, Mehmet Koray Adali1, Oguz Kilic1
1Cardiology Department, Pamukkale University Hospitals, Pamukkale, Denizli, Turkey.
Insights
An invasive strategy significantly reduces long-term mortality in elderly patients over 80 presenting with acute coronary syndrome (ACS). This approach is more effective than conservative treatment for this vulnerable population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Elderly individuals (≥80 years) have a high incidence of cardiovascular disease.
- Acute coronary syndrome (ACS) is a common presentation in the elderly.
- Optimal management strategies for ACS in octogenarians require further investigation.
Purpose of the Study:
- To evaluate the impact of an invasive strategy versus conservative management on long-term mortality in patients aged 80 and older with ACS.
Main Methods:
- A cohort of 156 patients aged 80+ admitted with ACS was analyzed.
- Patients were divided into an invasive-strategy group (coronary angiography, n=94) and a conservative-strategy group (medical management, n=62).
- Long-term mortality was assessed over a median follow-up of 8.5 months.
Main Results:
- The invasive-strategy group had significantly lower mortality (25.5%) compared to the conservative-strategy group (48.4%, p=0.006).
- Cox regression identified the invasive strategy as a significant predictor of reduced mortality (OR: 0.26, p=0.001).
- Factors associated with increased mortality included ST-segment elevation myocardial infarction, low ejection fraction (<40%), and higher GRACE risk scores.
Conclusions:
- An invasive strategy offers significant benefits in reducing long-term mortality for elderly patients (≥80 years) presenting with ACS.
- This approach should be considered for managing ACS in the octogenarian population.
- Further research may refine risk stratification and treatment selection within this demographic.
Objective:
The elderly have the highest incidence of cardiovascular disease and frequently present with acute coronary syndrome (ACS). In this study, our aim was to evaluate the effect of an invasive strategy on long-term mortality in patients of 80 years and older presenting with ACS.
Methods:
Patients who were admitted to hospital with ACS were recruited using appropriate ICD codes in the computerised hospital data system. After exclusion of patients below 80 years old, the remaining 156 patients were involved in the final analyses. Ninety-four of 156 patients (60.3%) underwent coronary angiography and they constituted the invasive-strategy group, whereas the remaining 62 (39.7%) patients were treated medically and they constituted the conservative-strategy group.
Results:
Median follow-up duration of patients was 8.5 (0-61) months. Total mortality at the end of the follow-up period was 24 (25.5%) patients in the invasive-strategy group and 30 (48.4%) in the conservative-strategy group (p = 0.006). According to Cox regression analysis, the invasive strategy (OR: 0.26, 95% CI: 0.12-0.56, p = 0.001), presentation with ST-segment elevation myocardial infarction (OR: 7.76, 95% CI: 1.74-34.57, p = 0.002), low ejection fraction below 40% (OR: 3.11, 95% CI: 1.43-6.76, p = 0.004), heart rate (OR: 0.98, 95% CI: 0.96-0.99, p = 0.013) and GRACE risk score between 150 and 170 (OR: 7.76, 95% CI: 1.74-34.57, p = 0.002) were related to long-term mortality.
Conclusions:
Our results show the benefit of the invasive strategy on mortality rate in elderly patients over 80 years old and presenting with ACS.
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